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HSA WITHDRAWAL AUTHORIZATION Refer to page 2 for reporting information MAILING ADDRESS: Horizon Trust Company P.O. Box 30007, Albuquerque, New Mexico 87190 FOR OVERNIGHT NIGHT MAIL ONLY: Horizon Trust
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How to fill out hsa withdrawal authorization
How to fill out hsa withdrawal authorization
01
To fill out an HSA withdrawal authorization form, follow these steps:
02
Obtain the HSA withdrawal authorization form from your HSA provider.
03
Fill out your personal information such as your name, address, and HSA account number.
04
Specify the amount you wish to withdraw from your HSA.
05
Indicate the reason for the withdrawal, such as medical expenses or qualified HSA distributions.
06
Provide any additional documentation or supporting evidence required by your HSA provider.
07
Sign and date the form.
08
Submit the completed form to your HSA provider either by mail, fax, or online submission.
09
Keep a copy of the completed form for your records.
Who needs hsa withdrawal authorization?
01
Anyone with a Health Savings Account (HSA) may need to fill out an HSA withdrawal authorization form.
02
This form is typically required when an individual wants to withdraw funds from their HSA for eligible expenses.
03
It is important to check with your HSA provider to determine if they require a withdrawal authorization form and what specific circumstances might necessitate its use.
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What is hsa withdrawal authorization?
HSA withdrawal authorization is a form that allows individuals to withdraw funds from their Health Savings Account.
Who is required to file hsa withdrawal authorization?
Individuals who wish to withdraw funds from their HSA are required to file a withdrawal authorization.
How to fill out hsa withdrawal authorization?
To fill out HSA withdrawal authorization, individuals need to provide personal information, details of the withdrawal amount, and the reason for the withdrawal.
What is the purpose of hsa withdrawal authorization?
The purpose of HSA withdrawal authorization is to ensure that funds are being withdrawn for qualified medical expenses as outlined by the IRS.
What information must be reported on hsa withdrawal authorization?
Information such as the account holder's name, account number, withdrawal amount, and description of the medical expense must be reported on HSA withdrawal authorization.
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